1.1 What diabetes is (in one sentence, then three layers)

Start simple: diabetes is chronic dysregulation of blood glucose due to insufficient insulin action. Then zoom in: insulin deficiency, insulin resistance, or both.

• Key terms: glucose, insulin, hyperglycemia, insulin resistance
• Skill: explain diabetes clearly to a patient in 20 seconds

1.2 Why we care: acute vs chronic harm

Acute: hypoglycemia, DKA, HHS. Chronic: vascular + nerve damage. Students learn to separate “today danger” from “long-term risk.”

2.1 The “glucose highway” model

Food → digestion → blood glucose → cellular uptake. Insulin as the “key” (or “traffic controller”).

• Pancreas: beta cells (insulin), alpha cells (glucagon)
• Liver as glucose buffer (glycogen storage + release)

2.2 Fed vs fasting state

Why fasting glucose is a useful test; what “baseline regulation” means.

2.3 Insulin resistance (intuitive mechanics)

Cells become less responsive → pancreas compensates → eventual failure for many type 2 pathways.

3.1 Type 1 diabetes: insulin deficiency

Concept: the body produces little/none insulin. Focus: what that means clinically, without memorizing obscure immunology.

• Common clues: rapid onset symptoms, weight loss, ketones, younger onset (but can occur at any age)

3.2 Type 2 diabetes: insulin resistance ± beta cell dysfunction

Most common form. Slow progression. Often asymptomatic early; screening matters.

3.3 Gestational diabetes: pregnancy physiology + future risk

Pregnancy insulin resistance is normal; some patients cross the threshold into gestational diabetes. Postpartum risk discussion.

3.4 Prediabetes: the “warning light” stage

How to talk about risk without shame: prevention, lifestyle changes, and follow-up testing.

4.1 Diagnostic tests (overview)

What each test measures and why clinicians choose one over another (availability, patient context, timing).

• Fasting plasma glucose (baseline control)
• Oral glucose tolerance test (how the body processes a glucose load)
• A1C (average glycemia over ~2–3 months)

4.2 Common diagnostic thresholds (learn the “big three”)

Education focus: students should know typical diagnostic cutoffs used in practice.

• Fasting plasma glucose: diabetes typically diagnosed at ≥126 mg/dL
• 2-hour OGTT: diabetes typically diagnosed at ≥200 mg/dL
• Random plasma glucose with classic symptoms: ≥200 mg/dL

Always interpret in clinical context and follow local guidance/protocols.

4.3 A1C: strengths and limitations

Why A1C is useful for “big picture” control, and when it can be misleading (e.g., altered red cell turnover).

5.1 SMBG vs CGM

Fingersticks are snapshots; CGM is a movie. Students learn when each is used and how to think in trends.

5.2 Targets: why “most adults” isn’t “everyone”

Typical targets are guidelines that vary with patient factors and treatment risk.

• Commonly cited targets for many non-pregnant adults: pre-meal 80–130 mg/dL; 1–2h after meals <180 mg/dL (varies by individual plan)

5.3 Hypoglycemia basics (recognize early)

Symptoms, common causes, and why rapid treatment matters.

• Common definition: <70 mg/dL as an alert threshold (levels of hypoglycemia are used clinically)
• Learn the “what would you do next?” mindset

6.1 Lifestyle pillars (practical, not preachy)

Nutrition, activity, sleep, stress, and the reality of behavior change. Students learn how to talk about goals without shame.

6.2 Nutrition fundamentals: carbs & glycemic response

Carbs raise blood glucose most directly. Introduce label reading, portions, and balanced meals.

• Carbs: “fast” vs “slow” digestion (conceptual)
• Protein/fat can change timing of post-meal spikes

6.3 Medication map (overview only)

Students learn categories at a high level: what they generally do and key safety considerations (no dosing instruction).

• Insulin (replaces missing insulin)
• Insulin sensitizers (improve response)
• Secretagogues, incretin-based therapies, glucose excretion mechanisms (conceptual)

6.4 Insulin basics (safe fundamentals)

Basal vs bolus concept, injection sites, and why timing matters. Focus: safety and understanding, not prescribing.

7.1 Hypoglycemia: the fast emergency

Signs, causes, and immediate first steps (education only). Includes the commonly taught “15-15” concept and why escalation is needed when severe.

7.2 DKA (diabetic ketoacidosis): the ketone story

Why insulin deficiency leads to ketones and acidosis. Recognition: dehydration, nausea/vomiting, abdominal pain, altered mental status.

7.3 HHS (hyperosmolar hyperglycemic state): extreme dehydration

Often in type 2. Very high glucose, severe dehydration, neurologic changes. Students learn “this is urgent.”

8.1 Microvascular: eyes, kidneys, nerves

Mechanism at a high level: chronic hyperglycemia damages small vessels and nerves.

8.2 Macrovascular: heart and brain

Diabetes increases cardiovascular risk. Students learn prevention thinking: blood pressure, lipids, lifestyle, medication adherence.

8.3 Foot care and neuropathy (practical)

Foot checks, skin care, early ulcer warning signs, and why small injuries become big problems.

9.1 “Teach-back” method

Students practice asking patients to repeat instructions in their own words — a proven way to reduce errors.

9.2 Medication safety & adherence barriers

Cost, complexity, side effects, fear of hypoglycemia. Learn how to ask better questions.

9.3 Health equity, stigma, and support

Diabetes care is not just biology. It’s access, food environments, stress, sleep, and support systems.

10.1 Case A — New diagnosis (type 2 pattern)

Student tasks: identify risks, propose education topics, suggest appropriate follow-up questions (no prescribing).

10.2 Case B — Hypoglycemia scenario

Student tasks: recognize symptoms, immediate actions, prevention discussion, escalation triggers.

10.3 Case C — Suspected hyperglycemic emergency

Student tasks: identify red flags and explain why urgent care is required.